Alumni Dissertations

 

Alumni Dissertations

Filter Dissertations By:

 
 
  • DOES END OF LIFE TERMINOLOGY INFLUENCE DECISIONAL CONFLICT IN SURROGATE DECISION MAKERS?

    Author:
    Dawn Fairlie
    Year of Dissertation:
    2014
    Program:
    Nursing Studies
    Advisor:
    Marianne Jeffreys
    Abstract:

    This study investigated the relationship between end of life terminologies and decisional conflict in surrogate decision makers using a convenience sample of 234 adults age 50 and older at active adult communities, and senior centers in New Jersey. Participants were randomized into two groups, and each received a vignette that was personalized. The vignettes varied only in the use of the words "Do Not Resuscitate (DNR)" and "Allow Natural Death (AND)". The Decisional Conflict Scale (DCS) was administered. There was no difference in total DCS score based on AND and DNR versions. However, AND respondents perceived their decision as a good decision, and were eight times more likely to sign the document than DNR participants, indicating that framing influences surrogate decision making at the end of life. Those who frequently attended religious services were twice as likely as those who rarely attend religious services of implementing their decision; whether the decision is to sign or not to sign the AND or DNR. Experienced decision makers (EDMs) evolved as a discreet group. They had lower mean total DCS scores and lower mean subscores, indicating that prior experience is an important aspect of end of life decision making. Additionally, AND and EDM participants were more likely to perceive their decision as good and were more likely to be to be sure of their decision, indicating that experienced decision makers respond more favorably to the words Allow Natural Death. The term AND lead to increased likelihood of actually making a decision. Respondents to the DNR version were likely to not sign or postpone signing. Finally, participants were more likely to withdraw from the study when the term DNR was used. Recommendations for end of life educational enhancements of nursing faculty, students, registered nurses, and all health care professionals are presented. Policy changes to increase public awareness and create a surrogate data base are recommended. The I am PreparedTM program is introduced. Future research is needed to improve adoption of advance directives and assist communication to help the dying and the surrogate decision makers that they leave behind.

  • Appreciative Inquiry to Transform Nursing Practice for Mentoring Children of Promise

    Author:
    Kathleen Falk
    Year of Dissertation:
    2013
    Program:
    Nursing Studies
    Advisor:
    Margaret Lunney
    Abstract:

    Abstract APPRECIATIVE INQUIRY TO TRANSFORM NURSING PRACTICE FOR MENTORING CHILDREN OF PROMISE By Kathleen Falk Advisor, Professor Margaret Lunney A Nurse-Mentoring Program based on Peplau's Interpersonal Relationship Theory (1952) and Erickson, Tomlin and Swain Modeling and Role Modeling Theory (1983) was implemented to promote optimum health and educational outcomes among children at high risk for intergenerational incarceration. The aim of this study was to reflect on the existing strength and effectiveness in the nurse-mentoring program for children with incarcerated parents, to lead the nurse-mentors in discovering what is important, and build a collective vision of the preferred future for mentoring this population. Through the appreciative inquiry (AI) process, a type of action research, nurses transformed their practice in assisting children toward healthy behaviors. Participants were RNs who enrolled in a Baccalaureate program and worked for at least 60 hours in the role of nurse-mentor. Data were collected through individual interviews and focus groups that resulted in consensus for an action plan. A dialectic-hermeneutic approach was employed to interpret the texts of participants who experienced working with Children of Promise and construct personal meaning from them. An action plan was implemented and evaluated after three months. Based on the evaluation, conclusions were drawn and a collective view emerged regarding best nurse-mentoring practices for this program and implications for other programs for children with incarcerated parents. The nursing theories were effective in helping participants to establish relationships with children in the context of mentoring.

  • Oncology Nurses and the Lived Experience of Participation in an Evidence-Based Practice Project

    Author:
    Mary Fridman
    Year of Dissertation:
    2011
    Program:
    Nursing Studies
    Advisor:
    Keville Frederickson
    Abstract:

    Abstract ONCOLOGY NURSES AND THE LIVED EXPERIENCE OF PARTICIPATING IN AN EVIDENCE-BASED PRACTICE PROJECT by Mary Fridman Nursing practice based on evidence is linked to improved patient outcomes. Barriers to evidence-based practice (EBP) in nursing have been identified at the individual nurse level, but recently increased attention has been paid to barriers at the organizational system and contextual level, and recommendations for organizational-level changes have been made and in some cases implemented. A gap in the EBP implementation literature is the qualitative study of the experiences of nurses who have engaged in EBP and is herein proposed as a prerequisite to the design of intervention studies. This paper presents a qualitative study using the phenomenological approach of M. Van Manen (1990) with the underlying philosophy developed by E. Husserl (1931). This study uncovered the lived experience of nurses' participation in an EBP project and drew from the experiences of nurses who had participated in an EBP project within an oncology academic hospital-based nursing setting that contains an organizational infrastructure of EBP. The Power as Knowing Participation in Change theory was found to be applicable to the findings. Keywords: Implementation science, Evidence-Based Practice, Qualitative, Phenomenology, Barrett's theory of power

  • Afro-Caribbean Mothers' Cultural Perceptions of their Child's Weight and Food Practices in London and New York

    Author:
    Heather Gibson
    Year of Dissertation:
    2013
    Program:
    Nursing Studies
    Advisor:
    Keville Frederickson
    Abstract:

    The World Health Organization has argued that greater efforts are needed to prevent and manage childhood obesity. In urban cities, the Black sub-group of Afro-Caribbeans has a high rate of childhood obesity and overweight. The purpose of this study was to analyze Afro-Caribbean mothers' cultural perceptions in London and New York regarding childhood weight and food practices in children age 6 to 12 years. This qualitative content analysis, guided by the Developmental Niche, used a purposive sample of 30 Afro-Caribbean mothers to illuminate cultural perceptions of food and weight in their children. Semi-structured in- depth interviews were conducted with 15 mothers in both London and New York City. Each participant completed a demographic questionnaire that also included two quantitative questions. The first measured mother's perception of weight using a visual image and the other assessed the written description of the child's weight. The eight themes that emerged were: perceptions of childhood obesity within the general population; parents' role in child obesity; physical activity (PA); weight of child; cooking techniques; types of food consumed; food is a social bond that connects child with others; and food preparation varies according to families. Additionally, there were 29 subthemes such as: extracurricular PA is expensive, lack of knowledge about what constitutes a healthy weight, health care provider's involvement, cultural techniques modified and eating as a way to maintain cultural rituals. More than one-quarter of the mother's (27%) in both London and New York had overweight or obese children. In general, mothers tended to select a visual image that showed their children at a lower weight than their actual size. Furthermore, most mothers of overweight and obese children did not perceive their children as such in their responses to the visual images. The implications for nursing practice and future research include increasing cultural competence for nurses, health care providers and students; increasing parent education regarding healthy food substitutes and weight recognition; developing policies to increase physical education for children; and providing weight and nutrition interventions to the extended family.

  • The Lived Experience of Young Adult Burn Survivors' Use of Social Media

    Author:
    Marie Giordano
    Year of Dissertation:
    2014
    Program:
    Nursing Studies
    Advisor:
    Margaret Lunney
    Abstract:

    The purpose of this phenomenological study was to illuminate the meaning of social media use by young adult burn survivors. Five females and four males, aged 20-25, who sustained burns > 25%, were interviewed. Van Manen's (1999) phenomenological methodology provided the framework for this study. The meaning of the context of the lived experience is described in the five essential themes of identity, connectivity, social support, making meaning, and privacy. These young adult burn survivors, having experienced the traumatic effects of a burn during adolescence, use social media as a way of expressing their identity, while being cautious about privacy. Part of that process involves connecting others to enable a flow of social support and information, which is motivating and encouraging. Social media facilitates an accessible exchange of information that helps young adult burn survivors make meaning out of the traumatic event. The Neuman Systems Model was found to support the findings of this study.

  • Hypertension Knowledge, Expectation of Care, Social Support, and Adherence to Prescribed Medications of African Americans with Hypertension Framed by The Roy Adaptation Model

    Author:
    Andrea Grant
    Year of Dissertation:
    2013
    Program:
    Nursing Studies
    Advisor:
    Keville Frederickson
    Abstract:

    Hypertension (HTN) prevalence in African Americans contribute to higher rates of disabilities and deaths from stroke, myocardial infarction, and end stage renal disease than all other racial groups in the United States. The major reason documented for these poor health outcomes is related to lower HTN control rates among African Americans compared to other racial/ethnic groups. Though overall HTN awareness, pharmacological treatments and control have significantly improved for all populations, studies found that rates of HTN control and adherence with anti-hypertensive medications are lower for African Americans compared to other subgroups. Study Aims The primary aim was to determine whether hypertension knowledge, expectation of care, and social support are predictors of adherence to prescribed medications while controlling for socioeconomic factors in the context of hypertension among African Americans. Methods A cross sectional quantitative approach was used. A secondary data analysis was conducted with 387 hypertensive African Americans. The Morisky Medication Adherence scale was used to measure adherence, internal consistency was established, (r=.61). The Roy Adaptation Model (RAM) was used to link HTN knowledge, expectations of care, social support, and socioeconomic factors with adherence to medications to provide an understanding of the process of adaptation. Logistic regressions were used to determine the relationships among the variables. Results The sample (N=387) was primarily female (76%) and men (24%). On average, participants scored high in knowledge about hypertension; mean knowledge score was .91 (SD = .09). Controlling for patient covariates, hypertension knowledge was not found to be a predictor of adherence to prescribed medications (p=.469). Expectation of care was found to be a predictor of adherence to prescribed medications (p=.008); social support was found to be a predictor of adherence to medications (p=.006). Conclusion and Implications This study supports findings regarding expectations of care, social support, and adherence to medication in African American patients with hypertension. The findings are useful for planning patient management initiatives specific to chronic disease such as hypertension.

  • Core Competency Model for the Family Planning Public Health Nurse

    Author:
    Caroline Hewitt
    Year of Dissertation:
    2012
    Program:
    Nursing Studies
    Advisor:
    Carol Roye
    Abstract:

    It is important to define competency for both individual and organizational performance. Without defining the competencies that are necessary for a given job, it is not possible to hire, train or evaluate workers with the requisite skills. Although competency models have been developed for the general public health workforce and adapted by various public health specialties, like public health nursing, competencies for the family planning (Title X) public health nurse have not been specified. For this study a competency model was developed through expert consensus using a three stage Delphi Method. Expert consensus was sought using an expert panel of 40 family planning senior administrators, community/public health nursing faculty and seasoned family planning public health nurses. The initial survey was developed from the 2011 Title X Family Planning program priorities as well as commonly offered family planning clinical services. The 32 item survey was distributed electronically via SurveyMonkey®. The study results suggest that the Delphi Method was a successful technique through which to drive consensus amongst a panel of family planning experts. Panelist attrition was low, and participation robust resulting in the final 28 item model. Competencies with at least 75% consensus were included in the model and those competencies were primarily related to education/counseling and administration of medications and contraceptives. Implications of this study relate to education/training, certification and workplace performance.

  • Motivational Factors, Professional Values and Associate Degree Nursing Students' Intent to Continue Their Formal Education: Application of Structural Equation Modeling

    Author:
    Unn Hidle
    Year of Dissertation:
    2011
    Program:
    Nursing Studies
    Advisor:
    Martha Velasco-Whetsell
    Abstract:

    The level of nursing education has been shown to influence nursing care with a direct correlation between higher nursing education and improved patient outcomes. However, only 16-20% of Associate Degree (AD) nurses return to school for a higher degree in nursing. Studies have focused on barriers why practicing AD nurses do not pursue further education, though, no study to date has looked at motivational factors for AD nursing students to continue education. This quantitative structural equation modeling (SEM) study investigates the relationship between motivational factors, professional values and the intent to continue formal post-AD nursing education for AD nursing students in their last semester. The framework for the study is based on the conceptual framework of Deci and Ryan's Self-Determination Theory (SDT), elements of a literature review, which provides linkages between intention to attain a post-AD nursing degree, motivational style, and professional values to create the theoretical framework. A sample of 62 AD nursing students in their last semester of nursing at major community colleges in New York City participated. Self-administered questionnaires included the Academic Motivation Scale (AMS C-28), the Nursing Professional Values Scale Revised (NPVS-R), and a personal questionnaire developed by the researcher. Data analysis showed that AD nursing students with high professional values were self-determined with high intrinsic motivation. The majority of AD nursing students intended to pursue further education, however, intrinsic motivation did not have a direct effect in their intent decisional process. Finally, professional values did not have a direct effect on intent to continue education, but indirectly, professional values were a supportive factor of intrinsic motivation. Implications of this study support the enhancement of professional values in the AD nursing curriculum. Additional factors in the intent decisional process, including extrinsic motivators, should be explored in future research.

  • Living With HIV Disease: A Phenomenological Study of a Group of Older Black/African American Women

    Author:
    Judith James-Borga
    Year of Dissertation:
    2013
    Program:
    Nursing Studies
    Advisor:
    Keville Frederickson
    Abstract:

    Abstract LIVING WITH HIV DISEASE: A PHENOMENOLOGICAL STUDY OF A GROUP OF OLDER BLACK/AFRICAN AMERICAN WOMEN by Judith C James-Borga Adviser: Professor Keville Frederickson Black/African American women are disproportionately affected by human immunodeficiency virus (HIV) disease. The purpose of this study was to gain an in-depth understanding of the experiences of a group of lower socioeconomic, older Black/African American women, who were living with HIV disease. A purposive sample of ten participants was obtained and data was collected through unstructured interviews. Using the phenomenological stance of Merleau Ponty, and guided by van Manen's methodological processes, seven essential themes emerged: transcending adversity and becoming; using knowledge as empowerment; dealing with HIV stigma; concealing and revealing; tending to their emotional life; and caring for others while they themselves were being cared for. The meaning of living with HIV disease is a dynamic interrelated patterning process of these essential themes. The findings support Pamela Reed's theory of Self-Transcendence. Implications for nursing include: the urgent need for a paradigm shift that acknowledge the strengths of older Black/African American women; the need for the integration of sexual assessment and education on risk reduction and medication adherence into routine healthcare encounters; and for further research to expand the data base on strategies that older Black/African American women use to overcome diversity and live with HIV disease. Key Words: HIV; older Black/African American women; self-transcendence.

  • Reconciling Life Balance: A Grounded Theory Study of Overcoming Failure

    Author:
    Kathleen Karsten
    Year of Dissertation:
    2013
    Program:
    Nursing Studies
    Advisor:
    Barbara DiCiccio-Bloom
    Abstract:

    Academic failure has been described as endemic in nursing education. Although, associate degree nursing programs graduate the largest number of nurses each year, the on-time graduation rate is 59%. Every semester students fail nursing courses and are required to successfully repeat the course before they can progress in the nursing program. Students who re-take a failed course are often called "repeaters." This qualitative Grounded Theory research explored the process of overcoming failure and becoming a successful student repeater. This emergent mode grounded theory study applied qualitative analysis techniques to prospectively verify and refine this emergent concept by delineating dimensions embedded in overcoming failure. Through the constant comparative method of data analysis, selective and theoretical coding, the Grounded Theory Reconciling Life Balance emerged. Reconciling Life Balance represents the basic social-psychological process of nursing students who failed a course, repeated the course successfully and continued to complete their nursing program. Two substantive categories emerged from this data: 1) acknowledging, which included the concepts of the unexpected and failure and 2) becoming a successful repeater, which included the concepts of managing emotions, asking for help and adjusting their work-life balance. By focusing on human interaction and emotional connections, Reconciling Life Balance has the potential to transform current approaches to nursing education and facilitate student success.